Aims
The aims of this cross-sectional study are to determine the rate and predictors of endoscopic mucosal healing among IBD patients on non-biologic therapy in a resource-limited setting. We hypothesize that specific clinical and treatment-related factors are associated with the likelihood of achieving endoscopic mucosal healing in patients with IBD, and that clinical remission correlates poorly with endoscopic mucosal healing.
Methods
A cross-sectional study was carried out at Tikur Anbesa Specialized Hospital in Addis Ababa, Ethiopia, from January 2023 to September 2023. The study included all consecutive IBD patients on treatment for at least 6 months who attended follow-up at the GI clinic during the study period, were willing to give consent, and agreed to undergo follow-up colonoscopy. Data was collected using a structured, pre-tested questionnaire directly from patients and from electronic medical records. Endoscopic mucosal healing was evaluated with SES-CD for Crohn’s disease and the Mayo endoscopic sub-score for ulcerative colitis.
Results
Out of the 106 patients included in this study, 69 (65.1%) were in clinical remission. Thirty-five IBD patients (33%) achieved endoscopic mucosal healing. More patients with ulcerative colitis achieved endoscopic mucosal healing compared to those with Crohn’s disease (47% vs. 29%). Ten out of 32 (31.25%) CD patients with a history of bowel resection achieved endoscopic healing. Of the 69 patients in clinical remission, only 27 achieved endoscopic mucosal healing (39.1%). Higher ESR values (P = 0.040, AOR 0.946 with 95% CI 0.898-0.997) and younger age at diagnosis (P = 0.046, AOR 1.322 with 95% CI 1.005-1.739) predicted the absence of endoscopic mucosal healing.
Key baseline characteristics and multivariable predictors of endoscopic healing in IBD patients on non-biologic therapy
|
Variable |
Healed (n=35) |
Non-healed (n=71) |
AOR (95% CI) |
P value |
|
Age at diagnosis (years) |
31 (17–59) |
25 (13–56) |
1.322 (1.005–1.739) |
0.046* |
|
Duration before diagnosis (months) |
24 (0–300) |
18 (0–144) |
0.991 (0.963–1.021) |
0.567 |
|
Montreal Classification (CD) B1 B2 B3 |
14(40) 5(14.3) 7(20) |
16(22.5) 30(42.3) 15(21.1) |
4.678 (0.176–124) |
0.17 |
|
ESR (mm/hr) |
30 (2–110) |
48 (2–170) |
0.946 (0.898–0.997) |
0.040* |
Values shown as median (range) or n (%)
CD: Crohn’s disease
AOR: Adjusted Odds Ratio
*P < 0.05
Conclusions
Clinical remission did not consistently indicate endoscopic mucosal healing in this cohort: only 39% of patients in clinical remission showed mucosal healing, whereas 21.6% of those not in clinical remission achieved mucosal healing. These results reinforce the evidence that relying solely on clinical assessment to evaluate disease control among inflammatory bowel disease patients has limitations; therefore, including follow-up colonoscopy in routine care—even in resource-limited setting, will improve treatment decisions and may lead to better patient outcomes.